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© Journal of the Indian Academy of Applied Psychology
July 2010, Vol.36, No.2, 197-206. Special Feature

Reflections on Repetitive Intrusive Thoughts: Diagnostic
Dilemmas and Beyond
R. Tripathi and S. Mehrotra
National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore

Repetitive thoughts (RTs) are normal phenomena; however, these also form
essential features of various psychiatric syndromes. This paper describes two
unusual adult cases of repetitive thoughts. Both the cases were characterized by
emergence of repetitive images and thoughts that were intrinsically pleasurable
and were in consonance with developmental concerns in early adulthood. The RTs
were not considered irrational by the individuals. The immediate consequences
described were that of pleasure and relief. The RTs acquired an intrusive quality
over time. The increasing frequency of intrusions was accompanied by decreasing
sense of control, heightened impairment in overall functioning and distress although
the RTs continued to be described as giving pleasure during their occurrence.
Despite warranting clinical attention, the presentation of the cases was atypical in
various ways and did not adequately match the criteria for any diagnosis. The
phenomenological description highlights the evolution of repetitive thoughts in terms
of qualities such as intrusiveness, ego-syntonicity as well as co-occurrence of
positive & negative affective tones. Using existing theoretical frameworks, the
possible psychological mechanisms underlying these presentations are discussed.
The paper raises several questions on repetitive, intrusive thoughts that need to be
addressed through further research.

Keywords: ego-dystonicity; ego-syntonicity; intrusive thoughts; mind wandering,
Repetitive thoughts;

R epetitive, prolonged and recurrent thoughts an anticipated event, or of some other stimulus
about one’s self, one’s concerns and or situation (Horowitz, Wilner & Alvarez ,1979).
experiences are mental processes commonly Intrusive thoughts need not be negative/
engaged in by all people (Harvey, Watkin, associated with a stressor; they may be neutral
Mansell, & Sharfan, 2004). Segerstrom, or positive and occur in many benign situations
Stanton, Alden, & Shortridge (2003) defined (Berntsen, 1996). However, the uncontrollable
repetitive thought (RTs) as a “process of or unpredictable nature of repetitive intrusive
thinking attentively, repetitively or frequently thoughts may result in distress. Although
about one’s self and one’s world”. repetitive thoughts (RTs) can be a part of a
Repetitive thoughts (RTs) may be normal thinking process, research has shown
considered as intrusive when these “intrude that they can have both constructive and
into conscious awareness against a person’s unconstructive consequence (Watkins, 2008).
will and their occurrence interrupts ongoing Several psychiatric syndromes are associated
activity by capturing attentional resources” with repetitive thoughts such as depression,
(Clark, 2004). They are usually defined as generalized anxiety, phobia, post traumatic
unbidden, uncontrollable, and “generally” stress disorder (PTSD) and obsessive
unwanted thoughts or images of a past event, compulsive spectrum disorders.
198 Repetitive Intrusive Thoughts

Repetitive, intrusive and distressing OCD with regard to their experience of
thoughts have been empirically investigated unwanted, obsessive-like intrusive thoughts,
most often in the context of obsessive images and impulses. They found that 84
compulsive disorder (OCD) as these percent of their non-clinical participants
constitute the hallmark features of OCD. reported unwanted cognitive intrusions that
Obsessional thoughts are ideas, images, or were qualitatively similar in form and content
impulses that enter the individual’s mind again to the clinical obsessions of patient with OCD
and again in a stereotyped form. They are (Clark, 2004). These findings were replicated
almost invariably distressing (because they in several studies (Calamari & Janeck, 1983;
are violent or obscene, or simply because they Freeston, Ladouceur, Thibodeau, & Gagnon,
are perceived as senseless) and the sufferer 1991; Salkovskis & Harrison, 1984).
often tries, unsuccessfully, to resist them. They A scan at the available published
are however, recognized as the individual’s literature suggests that a bulk of the research
own thoughts, even though they are concerns itself with repetitive thoughts (RTs)
involuntary and often repugnant (ICD-10, that are perceived as intrusive, ego-dystonic
WHO, 1992). The research diagnostic criteria and distressing in nature. Although as
of ICD -10 (WHO, 1993) specify that indicated earlier, by definition, intrusive quality
experiencing the obsessive thought or of thoughts refers to merely their coming
carrying out the compulsive act should “not in “unbidden” into the ongoing stream of
itself be pleasurable”, though there may be consciousness rather than to their inherently
temporary relief from tension/anxiety. pleasant/unpleasant content; repetitive
Contemporary definitions of obsessions thoughts (RTs) that are intrusive in nature are
emphasize to varying degrees, the five core generally described as distressing. The
features of obsessional phenomena namely, literature is relatively sparse on description of
intrusive quality, unacceptability, subjective intrusive thoughts that may have both
resistance, uncontrollability and ego pleasurable as well as distressing components
dystonicity ( Clark, 2004). These five core and may not be clearly ego-dystonic in nature.
features are the dimensions on which specific The clinical presentation and nosological
obsessional content may vary in degree or status of such experiences as well as the
intensity Ego-dystonicity, as a dimension of psychological mechanisms/factors involved
OCD refers to the degree to which the content therein are issues that have been insufficiently
of the obsession is contrary to or inconsistent explored in the empirical literature. This paper
with a person’s sense of self as reflected in examines these issues in the context of two
his or her core values, ideals and moral cases that illustrate repetitive thoughts
attributes. Ego-dystonic intrusive thoughts are accompanied by atypical features in their
not the type of thought, image, or impulse that presentation. Both these cases were seen in
a person would expect of himself or herself the Psychiatry outpatient department of a
and so the obsession represents a threat to tertiary care setting in a metropolitan city in
the person’s self view (Purdon, 2001; Purdon South India.
& Clark, 2000).
In 1978, Rachman and De Silva (1978)
published a controversial study that Mr. A, a 24-year-old undergraduate
challenged the conceptualization of unmarried male, presented with a six month
obsessions and compulsions as categorically history of repeated sexual images and
distinct phenomena with no connection to the thoughts, high frequency of engagement in
non-clinical population. In two studies they masturbation, and significant disturbances in
compared non clinical subjects and those with personal, social and occupational functioning.
R. Tripathi and S. Mehrotra 199

The history revealed the presence of two Towards the later phase, the high frequency
depressive episodes and one hypomanic of the episodes and resulting interference in
episode in the past and a life time diagnosis daily life became a source of distress though
of Bipolar Affective Disorder (BPAD) was the episodes continued to be experienced
entertained. However at the time of as pleasurable to some extent. In addition,
presentation, BPAD was in remission and the he reported getting these intrusive images in
client had no symptoms of depression or social situations or when engaged in some
hypomania. There was no family history of task. This happened less frequently but would
psychiatric illness. premorbidly, he was shy, be characterized by higher levels of distress.
introvert and reported low self-confidence. A He started becoming anxious and tense about
detailed clinical evaluation revealed that Mr. approaching exams and his inability to control
A. started occasionally watching pornographic the episodes of repetitive images and
movies with friends when he was in 11 th thoughts. He reported these as his own
standard. During his last year of graduation, thoughts which he was unable to resist. His
this pattern generalized to watching such interactions with family members and friends
material at home too when he would be alone. declined significantly. He did not appear for
This exposure to erotic stimuli would be the exam saying that he was inadequately
accompanied by heightened experience of prepared but experienced guilt regarding the
arousal followed by masturbation and relief. same. He also reported worrying about his
For the initial two to three months, this pattern masturbatory practice. Initially he used to
of behaviors continued without any significant masturbate everyday before going to sleep but
interference in his functioning. Gradually, he he observed that he now had difficulty in
started watching pornography most of the time ejaculation at night. He started worrying about
when he was at home and would masturbate being impotent and not “manly enough” as he
four to five times in a day, resulting in believed that ejaculation was expected to
interruptions in his studies. He started getting occur in each instance of sexual arousal and
repeated sexual images of the movies masturbation.
watched earlier. These images would be often Case-2
triggered by seeing erotic stimuli (females or
pictures of females perceived as attractive) Mr. C. a 22-year-old undergraduate
but would also occur when he would be unmarried male presented with a four year
relatively unoccupied (in the absence of history of repetitive thoughts and images about
obvious external triggers/ cues). At the time future, procrastination and decreased
of presentation, he reported that these academic performance. There was no family
intrusive images were experienced 12-16 history of psychiatric illness. His personal
times in a day and would be followed by history revealed that he was quiet and shy in
thoughts about the images. He would typically nature, had difficulty communicating with
spend 6-8 hours in a day, in such episodes unfamiliar people, and making new friends.
consisting of sexual images and thoughts. The He also reported himself to be a person who
enquiry suggests that although the images was inclined to engage in fantasies. Mr. C
were perceived as intrusive/ coming unbidden, started getting repetitive thoughts and image
the subsequent engagement in thoughts about future when he shifted from a rural to
related to the images had some voluntary urban setting during his PUC and had difficulty
component. In some of these episodes, Mr A. in adjustment. The thoughts were repetitive (
reported experience of sexual urges leading RTs) and yet pleasant in nature and involved
to masturbation. He reported that these images and ideas about future, about
episodes generally had a pleasurable quality. becoming a professional and doing well in
200 Repetitive Intrusive Thoughts

society. To begin with, these were not early adulthood. These RTs were triggered
perceived as intrusive. However, engagement mainly by external stimuli especially in the
in these thoughts severely impaired his beginning phase, though in the second case,
academic performance and he failed his 2nd RTs were also triggered by negative mood
PUC exam. This failure was followed by a states such as dysphoria, anxiety, and
moderate depressive episode characterized boredom. The RTs were recognized as one’s
by pervasive feelings of sadness, decreased own thoughts and engagement in these
interest, decreased appetite and sleep, ideas thoughts gave rise to pleasure in both the
of helplessness, hopelessness and cases. In addition, the RTs were negatively
worthlessness. The episode remitted within reinforced in the 2nd case as these sometimes
two months without any treatment. During this resulted in termination of aversive mood states
episode the client did not recollect having (relief).
repetitive thoughts (RTs) with positive content Over time, the RTs increased in
as described above. There was a re- frequency and acquired an intrusive quality
emergence of repetitive thoughts (RTs), soon probably as a result of heightened salience. It
after remission of the depressive episode. is interesting to note that in this phase, their
These repetitive thought (RTs) would occur in were times when the clients would intentionally
episodes, the duration of which was variable direct their attention to these thoughts
ranging between 4 and 14 hours. He noticed (deliberate engagement in fantasy activity) as
that he had difficulty in paying attention in the well as other times when these thoughts would
class, and engaging in conversation due to spontaneously intrude into the ongoing stream
the constant absorption in these thoughts of consciousness. This phase was marked
about future. He was not able to read at home by experience of interference in regular
due to the repetitive thoughts (RTs) and started activities and distress. A careful line of inquiry
procrastinating academics related work. By reveals that the distress originated from the
this time, the thoughts had acquired an perceived consequences and implications of
intrusive quality. However there were also repetitive thoughts (RTs) (interference in daily
times when the client would actively, effort fully life and interruptions in important ongoing goal
engage in the RTs by not attending classes pursuits) rather than from the content of
regularly, sitting alone in an isolated place and thoughts per se. These RTs were not
dwelling on the thoughts. On a few occasions, considered by the clients as inconsistent with
such deliberate engagement occurred when or threatening to the core values of the self.
the client would be feeling bored, anxious or This suggests that the RTs in these cases
sad. Although Mr. C reported feeling ‘good’ tended to be more ego-syntonic rather than
when absorbed in these thoughts, he was ego-dystonic. With heightened frequency of
distressed about the impairment in his intrusions there was a decreasing sense of
functioning due to the RTs and sought control over the RTs in both the cases. In the
professional help. 2nd case, the time periods spent in RTs were
Discussion rather prolonged (several hours in a day) and
Phenomenology and its evolution: the client also reported drifting of attention to
the content of the RTs even when being
The two cases reported above share engaged in social conversations. This
some common features. Both the cases were description seems similar to mind wandering.
characterized by emergence of repetitive Mind wandering, a form of repetitive thoughts
images and thoughts (RTs) that were has been defined as “a shift of attention from
intrinsically pleasurable in nature and were in a primary task toward internal information,
consonance with developmental concerns in such as memory” (Smallwood & Schooler,
R. Tripathi and S. Mehrotra 201

2006). It is possible that mind-wandering may/ ruminations (Nolen-Hoeksema, 2000). The
may not be perceived as intrusive depending typical nature of ruminations in depression
on the nature of the ongoing stream of involve distressing thoughts that often pertain
thoughts, its importance and the situational to past events and their implications and are
demands. Mind wandering may be perceived perceived as ego-syntonic and not irrational.
as an intrusive activity when the ongoing tasks RTs are a key element of a number of anxiety
are structured, goal driven and demand high disorders too, namely; generalized anxiety
attentional resources. In a recent review, disorder, social anxiety and posttraumatic
Smallwood et al (2006) have argued that mind stress disorder (PTSD) (Watkin, 2008) and
wandering is a common phenomenon that obsessive compulsive spectrum disorders.
has been ignored by the mainstream cognitive Worry as a type of repetitive thoughts (RTs),
psychology. They partly attributed it to has been implicated in anxiety (Calmes &
multiplicity of operational definitions of this Roberts, 2007). According to Berkovec et al
phenomenon as revealed by the diverse labels (1983) worry is “a chain of thoughts and
used to denote it ( e.g. ‘‘task-unrelated images images, negatively affect-leaden and relatively
and thoughts,” ‘‘stimulus-independent uncontrollable” and is “an attempt to engage
thought,” ‘‘mind pops” and ‘‘zone outs” ). in mental problem solving on an issue whose
Smallwood et al, (2003) used the term day- outcome is uncertain but contains the
dreaming as a special case of mind possibility of one or more negative outcomes”
wandering. In fact the nature of RTs in the The RTs described in the two cases, lacked
second case was similar to what has been the essential features of either depressive or
described as “excessive day-dreaming”. worrisome ruminations. The RTs in question
Schupak and Rosenthal ( 2009) reported a were similar to those described in OCD, in
case with excessive and highly structured terms of their repetitiveness, intrusive quality,
daydreaming that contributed to significant and uncontrollability. However, these cases
distress although the content of the differed from patients with OCD in important
daydreaming was described as non-dysphoric ways. In OCD, obsessions and compulsions
and non-intrusive in nature. The authors are generally ego-dystonic and the content of
speculated that daydreaming may be treated obsessions typically (though not invariably)
as a special case of mind wandering, in as tends to be unacceptable and is accompanied
much as it involves more structured content by negative affect states. In the cases reported
rather than an experience of transient general here, the RTs per se lacked the ego-dystonic
inattentiveness. The authors argued for the quality and were accompanied by positive
possibility that their case might represent an affect states, though disturbance/distress was
unrecognized population of individuals whose reported as a consequence.
mind wandering/daydreaming is experienced The content of RTs in the first case was
as a factor producing psychological distress sexual in nature. There is considerable debate
or functional impairment without meeting about terminology in existing literature as to
criteria for a psychiatric disorder. how to categorize and define repetitive sexual
Context and diagnostic dilemmas: thoughts. In the present case it may be
RTs can contribute to depression and understood as compulsive impulsive sexual
anxiety (Borkovec et al, 1983) or form part of behaviors (Coleman, 1991), which involve a
these syndromes. They have been broad range of paraphilic or nonparaphilic
documented as processes underlying the symptoms. Paraphilic Compulsive-impulsive
onset and maintenance of depression and sexual behaviors (C–ISBs) involve
have been labeled as dysphoric /depressive unconventional sexual behaviors in which
202 Repetitive Intrusive Thoughts

there is a disturbance in the object of sexual part of one’s sexual script. In a substantial
gratification or in the expression of sexual minority of individuals, sexual fantasies also
gratification (e.g., exhibitionism, voyeurism). induce guilt and distress when such fantasies
Non-paraphilic Compulsive-impulsive sexual are negatively appraised. (Ellis and Symons,
behaviors (C–ISBs), on the other hand, involve 1990, Leitenberg & Henning, 1995).However
conventional sexual behaviors that have such fantasies are far less frequent,
become excessive or uncontrolled. In the first distressing and less difficult to control than
case, repetitive sexual thoughts and sexual obsessions in OCD.
masturbation may be considered as non- In the second case, although syndromal
paraphilic compulsive-impulsive sexual depression was documented in the past; the
behaviors. However, one should be cautious RTs were present much before the onset of
to use this terminology because there is a depressive episode and continued to occur
dearth of research on what might be later in the absence of syndromal depression.
considered normal or abnormal sexual
thoughts, especially in adolescence and early Both the cases had a few features that
adulthood. Repetitive sexual thoughts, images indicated an obsessional quality
and ideation are widely recognized as part of (intrusiveness, repetitiveness, loss of control)
normal fantasy life of the general population and yet there were also components
and not unique/specific to clinical conditions suggestive of intentional involvement and
such as OCD or paraphilias. There is however, absorption in the RTs (during their occurrence)
a virtual absence of empirical data on the which are characteristic of normal fantasies.
pattern of occurrence of repetitive sexual It is important here to discuss about two long
thoughts in this age group, in the Indian standing approaches to psychiatric
context. The cultural values as well changing classification (Stein, 2007). The classical
societal norms are likely to have an impact on approach, which has had an important
how individuals appraise such thoughts and influence on contemporary psychiatric
how they manage the same. nosology, has emphasized the idea that
psychiatric disorders are natural kinds, which
It is worth mentioning here the features can be defined in terms of their necessary and
that may be used to differentiate between sufficient criteria. Just as a square can be
sexual obsession and sexual fantasy. Gordon defined as a figure with four equal sides at
(2002) described “sexual fantasies as a right angels, so a psychiatric disorder can be
pleasant, harmless and relatively guilt- free. defined in terms of particular operational
They may represent unfulfilled wishes or criteria. A critical approach on the other hand,
memories of past sexual experiences”. Sexual has emphasized the idea that psychiatric
fantasies are considered an indication of disorders are socially constructed categories
sexual desire (Kinsey et al., 1948) and often and what count as a psychiatric disorder may
enhance sexual arousal are often seen as reflect the opinions and views of those who
purposefully internally generated. They may construct the nosologies more than the reality
include graphic details of a fantasized sexual per se. it has been argued that classical
script. In marked contrast to most sexual concepts of science, language and medicine
fantasies, the sexual ideation in OCD is highly do not stand up to careful scrutiny, and this
unpleasant and generally experienced as ego thinking has had an important influence on
dystonic, i.e. not in keeping with the person’s contemporary critique of psychiatric nosology.
values and sense of self, giving rise to a high Stein, (2007) argued in favour of an integrative
need to resist. Thus sexual obsessions in OCD approach to classification which would be
rarely produce sexual arousal, not being a based on cognitive affective science and
R. Tripathi and S. Mehrotra 203

would go beyond the classical and critical especially with reference to the co-occurrence
approaches. of distress and pleasure. The theory
Recent studies using factor analytic operationalizes the construct of “desire” as an
methods take into account the broad “affective charged cognitive event in which an
phenotypic heterogeneity of OCD by using a object or activity that is associated with
few consistent and temporally stable symptom pleasure or relief of discomfort” is the focus
dimensions. These can be understood as a of attention. The authors further propose that
spectrum of potentially overlapping “it can be a conscious wish or urge to gain
syndromes that are likely to be continuous with pleasure, relieve discomfort, satisfy want or
‘normal worries’ and extend beyond the to engage in consumatory behavior associated
traditional nosological boundaries of OCD with these outcomes.” The psychological
(Mataxix-Col et al, 2005). Whether the experiences in this state can include images
phenomena being described in the present or verbal thoughts about the attractive features
paper may be considered as variants of typical of appetitive objects or activities.
obsessions or could be considered in the The EI theory hypothesizes the role of
Obsessive –compulsive spectrums (Phillips, both basic associative processes and higher
2002) is an issue that needs further level elaborative processes in understanding
consideration and debate. human desires. The associative processes are
Psychological mechanisms: involved in emergence of apparently
spontaneous, intrusive thoughts about a
It is observed that both the clients were desired target that can arise while attention is
rather shy and introvert. The second client in primarily directed to another task. These may
addition, described himself as a person who take the form of verbal or image fragments.
was inclined to engage in fantasies. A detailed The processes underlying intrusive thoughts
probing suggest that in both the cases, the involve learned associations to internal or
emergence of RTs occurred in the background external antecedent events. The theory
of a discrepancy between the current life- enumerates five types of such events/triggers
situation & experiences on one hand and the namely; physiological deficit states, negative
desired states on the other hand. In the first affect, external cues, other cognitive activity,
case, this discrepancy appeared to be related and anticipatory responses to the target. One
to the perception of actual self as being less or more of these triggers were found to be
“manly” than desired whereas in the second applicable in both the cases presented. The
case, the discrepancy was to do with associations themselves may be classically
perceived and ideal achievement and status conditioned or they can be semantic or
in society. It is speculated that such episodic in nature (e.g., recall of past
discrepancies might have acted as one of the experiences). In these processes, the
background factors for the emergence of demands for controlled processing or working
repetitive thoughts (RTs). In the second case, memory are low, and this gives rise to the
it was observed that engagement in RTs was sense of spontaneity and intrusions in ongoing
at times used as a deliberate strategy for mental activity. It is further proposed that such
negative mood regulation. intrusive thoughts will be followed by
The elaborated intrusions theory (EI) of elaboration when the target elicits powerful
desire, propounded by Kavanagh Andrade & affective reactions or a keen sense of deficit.
May, 2005 provides a basis for The elaboration component of desire involves
comprehensively understanding the nature of effortful cognitive processes (controlled
the RT phenomena observed in both the case, processes) that are triggered by the intrusive
204 Repetitive Intrusive Thoughts

thought and its associated affective response. may be a consequence of factors such as
Relevant information is sought and is then conflicting internal standards/wants, reduced
retained and manipulated in working memory. self-monitoring, loss of attentional control and
The search is both internal (increasing the insufficient efforts to regulate. Conflicting
salience of physiological states, episodic internal standards were operative in both the
memories, and target-related cognition such cases being described. The content of
as expectancies) and external (increasing the intrusions being intrinsically pleasurable,
salience of relevant situational cues). This type would be likely to result in the desire to savor
of cognition is referred to as elaboration. Both /maintain the ongoing experience while the
intrusive and elaborated thoughts are often anticipated consequence of prolonged /
accompanied by strong affective tone and a repeated engagement would simultaneously
tendency for the appetitive thoughts to capture give rise to the need to terminate/reduce the
and retain attention. The phenomenology repetitive thoughts and images. Reduced self
observed in both the cases indicated presence monitoring and loss of attentional control after
of intrusive thoughts accompanied by pleasant the initiation of the chain of repetitive thoughts
affective tone that captured their attention seem especially applicable in the second
followed by elaborative processes such as case. Mr C. would be absorbed for several
thinking about ejaculation, priming of beliefs hours in pleasant fantasies, losing track of time
about masculinity( Case -1) inability to control and the immediate context. The engrossing
and its consequences in day-to-day life (Case- nature of the mental content is likely to make
1 & 2). it more difficult to initiate attempts/efforts to
Ironically, the predominant emotional regulate /control the chain of repetitive
reaction in many episodes of desire is thoughts (RTs) with desirable content.
hypothesized to be negative. As a precursor, On the whole, the two case illustrations
negative emotion primes awareness of raise several questions that need to be
specific deprivation, and once a desire-related addressed through further studies. The
thought emerges; awareness of any prevalence of repetitive thoughts (RTs) that
associated deprivation is further primed. The are intrusive in nature and yet are pleasant
affect is intensified in the context of expected and ego-syntonic is unknown in community
delay or frustration in target- acquisition. Also, as well as clinic samples and needs
attempts to control the intrusions during documentation. An investigation of such cases
elaborative processing can involve a sense would also help in unraveling the conditions
of guilt or anxiety about loss of control, as was under which pleasurable & ego-syntonic
observed in both the cases. The authors repetitive thoughts are likely to acquire
propose that such states of desire can be intrusive and distressing qualities. Yet another
marked by ‘cycles of elaboration, fleeting question that requires empirical investigation
rewards (e.g. consumatory fantasies) and is, whether in some individual, RTs of these
intensified sense of deficit when thinking about kinds are transient in nature arising in context
the desired targets’. of certain life phases/ ongoing stress and
Examining these phenomena within the hence require no intervention. Studies that
framework of self regulation- failures also throw light on the implications for self
highlights potential factors that might have regulation of these thoughts characterized by
contributed to their maintenance/perpetuation. ‘co-occurrence of positive and negative
Baumeister, Heatherton and Tice (1994) affective states’ as well as the range of
reviewed the studies which indicate that under- strategies used by individuals to manage the
regulation of thoughts, feelings and behaviors same, are likely to result in advancement of
R. Tripathi and S. Mehrotra 205

understanding in self regulation of mental Calmes, C.A., & Roberts, J.E. (2007). Repetitive
phenomena. The within- person variables that Thought and Emotional Distress: Rumination
may make certain individuals prone to and Worry as Prospective Predictors of
experience prolonged, significant distress and Depressive and Anxious Symptomatology.
Cognitive therapy and research, 30, 343–356.
impairment associated with such phenomena
and give rise to their perception as problematic Clark DA. (2004). Cognitive behavioral therapy for
OCD. New Yark, London: The Guilford Press.
experiences form yet another fruitful line of
scientific inquiry. Systematic research on the Coleman, E. (1991) Compulsive sexual behavior.
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Psychology and Human Sexuality, 4, 37–52.
that can be used to clarify the circumstances
under which such repetitive thoughts; images Ellis, B.J., & Symons, D. (1990) Sexual differences
in fantasy : An evolutionary psychological
or fantasy-activity might be considered
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abnormal phenomena warranting clinical 555.
attention. In addition, the theoretical,
Freeston, M.H., Ladouceur, R., Thibodeau, N., &
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Gagnon, F. (1991). Cognitive intrusion in a non-
considering these phenomena as variants of clinical population.I. Response style, subjective
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OCD.Sexual and Relationship Therapy,17, 4.
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Harvey, A.G., Watkin, E., Mansell, W., & Sharfan,
ego-syntonic content may, under certain
R. (2004). Cognitive behavioural processes
conditions, be perceived as intrusive and
across psychological disorders. Oxford, United
distressing and cause impairments in Kingdom: Oxford University Press.
functioning. The prevalence of such
Horowitz, M.J., Wilner, N., & Alvarez, W. (1979).
phenomena in non-clinic and clinic samples, Impact of event scale: a measure of subjective
the psychological processes underlying the stress. Psychosomatic Medicine, 41, 209–18.
same and their implications for clinical Kavanagh, D.J., Andrade, J., & May, J. (2005).
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examined in future research. elaborated intrusion theory of desire.
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921. Received: November 18, 2009
Revision received:March 10, 2010
Accepted: May 06, 2010
Acknowledgement: We gratefully acknowledge the inputs provided by Ms Deepali
Rao, PhD scholar, and Ms Reshma, M.Phil scholar, NIMHANS during clarification
of case history.
R. Tripathi, Clinical Psychologist, Department of Mental Health & Social
Psychology National Institute of Mental Health & Neuro Sciences (NIMHANS),
Hosur Road, Bangalore-560 029, Email: ravikesh_tripathi@
S. Mehrotra, PhD, Associate Professor, Department of Mental Health & Social
Psychology, National Institute of Mental Health & Neuro Sciences (NIMHANS),
Hosur Road, Bangalore-560 029, Email:

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